Rotator Cuff Injuries in Pitchers

What do Pedro Martinez, Trevor Hoffman, and Kerry Wood all share in common? Besides being successful major league baseball pitchers, each has sustained a rotator cuff injury to their pitching shoulder.

Rotator cuff injuries are a common ailment in baseball and affect pitchers at all levels. Typically, these injuries are the result of poor mechanics, overuse, or an acute (sudden) injury to the shoulder. During the throwing motion, very high demands are placed on the rotator cuff requiring proper strength, flexibility, and exercise maintenance. Early identification of rotator cuff injuries in pitchers is key to the successful management and treatment of the throwing shoulder.

Anatomy

The rotator cuff is comprised of four different muscles in the shoulder. These four muscles include the subscapularis, supraspinatus, infraspinatus, and teres minor. Functionally, these muscles allow our shoulder the ability to move though a great range of motion and perform multiple daily and sports related tasks.

Types of Rotator Cuff Injuries

• Rotator Cuff Tears and Strains: In pitchers, the cuff functions to help accelerate and decelerate the arm during throwing. As a result, tremendous stresses are placed on each muscle. If irritation and soreness are not properly treated, a tear can occur. Tears are typically a result of repeated stress on the muscle or tendon.

• Impingement: In pitchers, this injury can be classified into two categories, internal or external impingement.

  • Internal Impingement: Result of the underside of the rotator cuff being “pinched” between the humerus (upper arm bone) and the glenoid (joint socket off the shoulder blade) during the throwing motion.

  • External Impingement: The rotator cuff tendons are compressed between the humerus (upper arm bone) and the acromion (shoulder blade) causing irritation.
     

• Tendonitis: The rotator cuff can become inflamed as a result of overuse or overload. This type of injury is common in pitchers as a result of increased overhead activities without proper rest and recovery.

Signs and Symptoms of Rotator Cuff Injury in Pitchers

• Pain and tenderness in the shoulder.

• Pain in the shoulder with throwing.

• Shoulder weakness and fatigue.

• Loss of range of motion.

• Difficulty “getting loose” with excessive warm-up time.

• Constant “rubbing” of the shoulder.

• Control problems.

• Decreased velocity.

Treatment

The treatment of most rotator cuff injuries can be resolved with rest and proper rehabilitation. Rehabilitation for these injuries involves proper exercise, stretching, ice, and rest. Typically with pitchers, return to throwing should always be monitored and pain free. If pain and discomfort persists with activity, one should seek medical attention.

Shoulder Care

Proper care is imperative to maintain a healthy throwing shoulder. Without maintenance, pitchers typically experience injury and become less effective. The following are some helpful tips to assist in proper shoulder care:

• Proper Warm-up: Make sure to properly warm-up prior to throwing. Always remember, “You warm-up to throw, not throw to warm-up.” Developing a good warm-up routine for throwing can help decrease the risk of injury.

• Rest: Proper rest for the throwing shoulder is very important in the recovery and health of a pitcher. Make sure to allow proper rest between throwing days to allow the shoulder to fully recover.

• Ice: Ice is an excellent tool to use because of its ability to decrease inflammation and pain. Ice can be used after throwing or exercise for 15 to 20 minutes per treatment.

• Exercise Program: Developing an exercise program can help increase strength and flexibility while decreasing the risk of injury. These exercises can help condition your rotator cuff to better handle the stresses of throwing. Ask your local physician, physical therapist, or athletic trainer to help you design an exercise program that fits your needs.

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